Long-term prognostic value of resting heart rate in subjects with prehypertension

Background: Increased resting heart rate increases cardiovascular risk in individuals with hypertension. The extent to which such risk extends to people with prehypertension is not known. The purpose of this study was to determine whether elevated resting heart rate contributes to increased coronary heart disease (CHD) risk in people with prehypertension. Methods: The cohort for the current study consisted of 3275 persons from the Atherosclerosis Risk in Communities (ARIC) study, 45 to 64 years old in 1986 to 1989, with a mean follow-up of 10.1 years. The primary outcomes were CHD and all-cause mortality. Results: Individuals with prehypertension and elevated resting heart rate had 50% higher all-cause mortality than people with prehypertension and lower resting heart rate (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.0-2.15), which was essentially unchanged after controlling for age, ethnicity, gender, diabetes, smoking status, LDL-cholesterol, exercise, and use of antilipemic agents (P < .01). Similarly, in unadjusted analyses, CHD risk was 49% higher for people with increased heart rate (HR 1.49, 95% CI 1.03-2.14). In adjusted analyses, elevated resting heart rate remained a factor in increased risk of CHD in women (adjusted HR 2.18, 95% CI 1.08-4.42), but not in men. Conclusions: Resting heart rate is an easily accessible tool that may be helpful for stratifying CHD and mortality risk in people with prehypertension.